Apoptosis as a prognostic factor in colorectal carcinoma.

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We investigated the occurrence of apoptotic cell death in 104 colorectal carcinomas byterminal-deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labeling (TUNEL) in order to examine whether or not apoptosis might be useful as a prognostic factor. An apoptotic index (AI) was caluculated as the percentage of positine cancer cells per 1,000 cancer cells. The median value of AI was 4.1 (range, 1.9-4.7). Apoptosis was less frequently-observed in tumors with higher malignannt potential, such as tumors at advanced stages (Dukes B,C and D), than at Dukes A (p<0.05), and it was less frequent in tumors with evidence of moderate differentiation than in those with evidence of well differentiation (p<0.05). It was also less frequent in tumors with venous invasion or lymph node metastasis than in those without these features (p<0.05). Moreover, the subgroup with a high AI in tumors at Dukes stage C (five-year survival rates were 33% vs. 68%, p<0.05 ; Cox-Mantel). Our findings suggest that less apoptosis might result in greater progression of colorectal carcinomas and the rate of apoptosis might be one of the indicators of the degree of malignancy. Moreover, it appears that the frequency of apoptosis in tumor cells might be useful prognostic factor in colorectal carcinoma.